Cartoon: Why A Patient’s Time May Be More Valuable Than Her Physician’s
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Documenting To Death: Are EMRs Eroding The Soul Of Medicine?
Electronic medical record systems (EMRs) have become a part of the work flow for more than half of all physicians in the U.S. and incentives are in place to bring that number up to 100% as soon as possible. Some hail this as a giant leap forward for healthcare, and in theory that is true. Unfortunately, EMRs have not yet achieved their potential in practice – as I have discussed in my recent blog posts about “how an EMR gave my patient syphillis,” in the provocative “EMRs are ground zero for the deterioration of patient care,” and in my explanation of how hospital pharmacists are often the last layer of protection against medical errors of EPIC proportions.
Considering that an EMR costs the average physician up to $70,000 to implement, and hospital systems in the hundreds of millions – it’s not surprising that the main “benefit” driving their adoption is improved coding and billing for reimbursement capture. The efficiencies associated with access to digital patient medical records for all Americans is tantalizing to government agencies and for-profit insurance companies managing the bill for most healthcare. But will this collective data improve patient care and save lives, or is it mostly a financial gambit for medical middle men? At this point, it seems to be the latter.
There are, however, some true benefits of EMRs that I have experienced – and to be fair, I wanted to provide a personal list of pros and cons for us to consider. Overall however, it seems to me that EMRs are contributing to a depersonalization of medicine – and I grieve for the lost hours genuine human interaction with my patients and peers. Though the costs of EMR implementation may be recouped with aggressive billing tactics, what we’re losing is harder to define. As the old saying goes, “What good is it for someone to gain the whole world, yet forfeit their soul?”
| Pros Of EMR | Cons Of EMR |
| Solves illegible handwriting issue | Obscures key information with redundancy |
| Speeds process of order entry and fulfillment | Difficult to recall errors in time to stop/change |
| May reduce redundant testing as old results available | Facilitates excessive testing due to ease of order entry |
| Allows cut and paste for rapid note writing | Encourages plagiarism in lieu of critical thinking |
| Improves ease of coding and billing to increase reimbursement | Allows easy upcoding and overcharging |
| Reminds physicians of evidence-based guidelines at point of care | Takes focus from patient to computer |
| Improves data mining capabilities for research and quality improvement | Facilitates data breaches and health information hacking |
| Has potential to improve information portability and inter-operability | Has potential to leak personal healthcare information to employers and insurers |
| May reduce errors associated with human element | May increase carry forward errors and computer-generated mistakes |
| Automated reminders keep documentation complete | May increase “alert fatigue,” causing providers to ignore errors/drug interactions |
| Can be accessed from home | Steep learning curve for optimal use |
| Can view radiologic studies and receive test results in one place | Very expensive investment: staff training, tech support, ongoing software updates, etc. |
| More tests available at the click of a button | Encourages reliance on tests rather than physical exam/history |
| Makes medicine data-centric | Takes time away from face-to-face encounters |
| Improved coordination of care | Decrease in verbal hand-offs, causing key information to be lost |
| Accessibility of health data to patients | Potential for increased legal liability for physicians |
Why Would Any Doctor Accept Medicaid?
A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e. on average, she makes less than minimum wage when treating a patient on Medicaid).
The enthusiasm about expanding Medicaid coverage to the previously uninsured seems misplaced. Improved “access” to the healthcare system via Medicaid programs surely cannot result in lasting coverage. In-network physicians will continue to dwindle as their office overhead exceeds meager reimbursement levels.
In reality, treating Medicaid patients is charity work. The fact that any physicians accept Medicaid is a testament to their generosity of spirit and missionary mindset. Expanding their pro bono workloads is nothing to cheer about. The Affordable Care Act’s “signature accomplishment” is tragically flawed – because offering health insurance to people that physicians cannot afford to accept is not better than being uninsured.
After all, improved access to nothing… offers nothing. Inviting physicians to work for less than minimum wage so that politicians can crow about millions of uninsured Americans now having access to healthcare, is ridiculous. Medicaid expansion is widening the gap between the haves and the have-nots. The saddest part is that the have-nots just don’t realize it yet.
